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Biomedical subjects

E J Roldán

Publications and source records attributed to E J Roldán.

At least 19 recordsLinked to original sources
PubMed2001

Postmenopausal changes in the distribution of the volumetric BMD of cortical bone. A pQCT study of the human leg.

Three different regions of interest (ROIs) were defined in pQCT scans (XCT-3000 machine, Stratec, Germany) taken at the tibial mid-diaphyses of 12 pre-menopausal (pre-MP) and 12 post-menopausal (post-MP) women who were otherwise normal, according to the volumetric bone mineral density (vBMD) value of their corresponding pixels (voxels) as assessed by their respective attenuation values. They were classified as "low-vBMD" (LD-ROI, with a vBMD of 200-400 mg/cm(3)), corresponding chiefly to trabecular-subcortical bone; "medium-vBMD" (MD-ROI, vBMD = 400-800 mg/cm(3)), corresponding mainly to porous cortical bone or cortical-subcortical bone, and "high-vBMD" (HD-ROI, vBMD higher than 800 mg/cm(3)), corresponding to dense cortical bone. The fraction of the total cross-sectional bone area covered by the HD-ROI was 16% higher, and that covered by the MD-ROI 20% lower, in pre-MP than post-MP women. No differences concerning the LDROIs were found. A close, linearly negative relationship was found between the MD- and HD-ROI fractions in all the women together, with no inter-group differences in slope. The Stress-Strain Index (an indicator of the torsional stiffness and strength of the whole bones that involved both the vBMD and the spatial disposition of the HD bone in the cross-section - torsional moment of inertia -) correlated linearly and positively with the cross-sectional area of the HD-ROI, with a higher slope for pre-MP than post-MP women. Qualitatively, a. post-MP women showed a significantly more prevalent discontinuity of the voxels in the HD-ROI than pre-MP women, and b. the tendency of LD-ROIs to accumulate along the mechanically lesseffective (antero-posterior) axis of the image - a characteristic of pre-MP bones - was visually less evident in post-MP bones. These features describe non-invasively some changes induced by menopause in the human tibia that may be critical for defining the skeletal condition and to monitor the effects of treatments addressed either to protect or to improve mechanically the bone structure, beyond the possibilities of standard densitometry.

Journal Article↗
PubMed1998

Olpadronate: a new amino-bisphosphonate for the treatment of medical osteopathies.

Olpadronate is a nitrogenated bisphosphonate. Although it shares the therapeutic and pharmacological properties of pamidronate and alendronate, it has a greater dosage amplitude, more predictable effects and a greater digestive tolerability than other bisphosphates. Therefore, it may be more appropriate in the treatment of medical osteopathies, by both oral and parenteral routes of administration. According to various experimental and human models, the pharmacological potency of olpadronate is 5- to 10-times higher than that of pamidronate and close to that of alendronate. The two methyl groups bound to the nitrogen atom give the compound a high water solubility, which is about 8-times higher than that of the two other bisphosphonates. The lack of a terminal amino group in the side-chain of the molecule and the absence of crystallised forms of the compound in the digestive tract (due to its high water solubility) may avoid the potential for inducing oesophageal and gastrointestinal side-effects. These features may explain the high tolerability reported after the administration of doses of olpadronate (by the oral route) up to 5- to 10-times higher than the maximum tolerated dose of alendronate in Paget's bone disease and bone metastases, thus widening the possibilities for its clinical usage. In addition, initial pharmacokinetic studies suggest that olpadronate's oral bioavailability would fit into a confidence range of 2-4%, which contrasts with the erratic absorption shown by other highly potent bisphosphonates. The clinical efficacy demonstrated in preliminary studies in Paget's bone disease (including ultra-short treatments), and also in single-dose iv. therapy of hypercalcaemia of malignancies, renders olpadronate among the most promising bisphosphonate compounds, with potential use in the treatment of a variety of bone-involving diseases, such as osteoporosis, malignancies and rheumatoid arthritis.

Journal Article↗
PubMed1997

[Morphological studies of hydroxyapatite crystals exposed to disodium pamidronate].

"In vitro" effects of disodium pamidronate on hydroxyapatite crystals morphology, and some "in vivo" data from bone powder of tibia and vertebrae from treated young and mature rabbits are here reported. Hydroxyapatite, synthesized following Rigoli et al method, and bone powder from rabbits were studied with X-ray, infrared and raman emission techniques for crystallographic analysis. Adsorption studies were also performed with a balanced solution of hydroxyapatite exposed to different times, 48, 120 and 168 hours and concentrations 1 x 10(-5) M, 3 x 10(-5) M, 8 x 10(-5) M y 1 x 10(-4) M of pamidronate. Infrared and raman spectrometry were not conclusive due to technical bias, but X-ray difractograms showed pure hydroxyapatite crystals in an hexagonal system. At constant time, pamidronate concentrations were varied, showing after 48 hours of exposition, a slight growth in the 002 plane, an aleatoric behavior in 213 and a marked increase in 004. After 120 hours, 002 plane is steady with a net growth in 004 and 213. After 168 hours, the 3 mentioned planes grow in proportion to pamidronate concentrations, tending to enlarge the crystal shape. Plane 13 markedly grow with pamidronate 8 x 10(-5) M a 1 x 10(-4) M, which are biologically high concentrations. Potentiometric assessments, in the 1 x 10(-5) to 1 x 10(-4) M range of concentrations show that bisphosphonate was completely adsorbed to the crystals. Additional "in vivo" observations showed changes in bone powder crystals isolated from pamidronate treated young animals, involving a growing of planes 002 and 211, in samples from both epiphysis and diaphysis, regarding untreated samples. Changes were more evident at epiphysis. In mature rabbits, it was shown a decrease in basal plane 002 and growing at 210, 211 and 310 with a trend to enlarge the crystal shape in diaphysis and to shorten it in vertebrate spongiosa. The "in vivo" doses are equivalent to those used by Ferretti et al. in intact rats with pamidronate low dose groups, showing an improvement of bone material properties and stiffness. Thus, it may rather be lower than the "in vitro" used concentrations. In concordance with above experimental conditions it can be concluded that bisphosphonates exert morphological changes in hydroxyapatite crystals, in a dose dependent manner, at least when high concentrations are used. In addition, it is postulated that changes observed on "in vivo" samples may be the result with other adaptative factors as for example the local mechanical usage. The latter data were limited, and should be studied with more details if an extrapolation to the bisphosphonate treated osteoporotic women is intended. Finally, it is suggested that any agent that changes BMU activity (all known anti-osteoporotic drugs) may potentially modify the quality of hydroxyapatite crystals, affecting in turn the bone resistance to fracture, independently from the quantity of bone mass gained. Thus, to help predicting the consequences on skeletal fragility, there is a need to know the direct or indirect effect of drugs on bone crystals.

Animals↗
PubMed1997

[Extended use, up to 6 years, of an oral amino-bisphosphonate in patients with established osteoporosis].

In osteoporotic women (n:163), 63.8 (+/- 8.1) years old and 15.2 (+/- 8.3) years since menopause, oral (200 mg/day) pamidronate was administered during protracted periods, up to 6 years. During the first 4 years of therapy significant increases from basal in both, lumbar spine and femoral neck were reported (p < 0.01). Patients who underwent to 5-6 years of treatment also showed positive results in both skeletal sites. Whole body mineral content estimated a 23.8 g/year mean gain during a 4-year period. Biochemical bone markers of resorption and formation reflected a variable degree of bone turnover decrease. Such changes were more pronounced at the beginning, and remained steady after the first year of continuous therapy. Calcemia remained between normal range without any hypocalcemic episode being reported. Phosphatemia, within normal range, showed a smooth trend to increase. PTH remained within normal range and vitamin D tended to slightly increase. The total number of new bone fractures and total number of patients with new fractures were less frequent during the pamidronate treatment period than before (p < 0.01). Indeed, the relative risk (RR) of fracture was estimated comparing the treatment lapse, 495 patient/year, vs a pretreatment period of 1,814 patient/year. Overall RR resulted less than 1 (RR = 0.83; CI 95% = 0.53-1.26). In total, hip, forearm and "other" fractures, RR was also less than 1 and remained over 1 in vertebral fractures. The latter can be explained because our sample started its treatment probably in a period of increased spine crushing. Overall fracture results, in a sample of patients as own controls and in spite of differences in ages, suggested that during treatment, patients improved their skeletal biomechanical competence, mainly in sites where cortical bone plays a meaningful role, as in femoral neck. It is concluded that pamidronate is an effective tool to ameliorate the skeletal conditions of postmenopausal osteoporotic women.

Administration, Oral↗
PubMed1997

[Clinical application of bisphosphonate's pharmacokinetic principles].

Bisphosphonates are a group of osteotropic substances able to modulate bone metabolism in different ways. They all display similar pharmacokinetic characteristics when administered in proportional dosages and assessed by similar methods. With the exception of olpadronate which is soluble in water, bisphosphonates have poor solubility, and may easily precipitate in the digestive media. In spite of their low digestive absorption (Bioavailability: 0.3-5%), they are effectively administered by oral route. Once in plasma they distribute rapidly, being uptaked by mineralized tissues, plasma proteins or eliminated by renal filtration in few minutes. The fraction retained in bones may be stored for long periods (from months up to 10 years depending on the compound) in an apparent inactive compartment. The risks of newly released molecules may be related to the potency of the drug. Within the clinical range of doses, bisphosphonates are not retained in soft tissues. This may explain the lack of extraskeletal collateral effects. Plasma blood levels are scarcely related to the clinical activity. Therefore, dosage may be guided better by biochemical markers of the bone disease than by the standard kinetic variables. On the other hand, dose is independent from age and/or body weight. Only renal impairment may induce additional dose adjustments.

Animals↗
PubMed1997

[Tolerability of oral bisphosponates in patients with osteoporosis and other osteopathies].

Oral nitrogen containing bisphosphonates (NCB) are effective drugs to inhibit bone metabolism turnover in osteoporosis and other bone diseases. Notwithstanding, some digestive disturbances create concern on the long term acceptance of the oral route. Side effects are mainly caused by low absorption and poor solubility in digestive content. Therefore the compound may precipitate and irritate the mucosas. Furthermore, the administered amount of a particular molecule, its intrinsic potency to irritate digestive walls and the degree of exposition to such sensitive tissue are other facts that combined, may determine the clinical tolerability. Thus, a single factor cannot predict the clinical tolerability. Pamidronate, alendronate and olpadronate are the main NCB under clinical usage. Alendronate is 10 times more potent than pamidronate but possesses a similar slight solubility (2.4 vs 3.0% W/V respectively). It also seems to be more (3 times fold) ulcerogenic in experimental assays. The current available pamidronate formulation protects from esophagus and gastric exposition. Up to now and until randomized clinical trials be performed the selection of the most tolerated aminobisphosphonate in clinical practice will depend on the interplay of many factors (table 1 shows a hypothetical view). Moreover, different patients may react dissimilarly depending on their sensitivity to a particular factor. Olpadronate is free-soluble (24% W/V), almost equipotent with alendronate (figure 1) and seems to lack relevant irritation potential, but clinical data is on its early phases and is still not available. Micronization of the bisphosphonate preparation may be of help to improve tolerability as shown with newer pamidronate oral formulations. The current clinical published data shows more or less the same safety profile for pamidronate (only when enteric coated capsules are used) as alendronate, with more than 90% of patients complying with long term treatments. Anyway the trials are not entirely comparable as said before. Some other pamidronate formulations proved to be intolerable and have not been accepted. Identifying the many factors of oral NCB's digestive tolerability may help with their clinical management. And in those countries where the two compounds are available they may alternatively be used in the sensitive patients. Finally, extra-digestive side effects, not commented in this article, should also be weighted when selecting a bisphosphonate.

Adult↗
PubMed1996

Mineral density gain in vertebrae of osteoporotic women on oral pamidronate reverts a year after treatment discontinuance.

Long-term treatment with 200 mg dry weight/day of pamidronate (APD) by oral route has been proposed to increase bone mineral density (BMD) in postmenopausal osteoporotic women. However, there is widespread concern over the possibility of bone metabolism "freezing" by protracted use of medication liable to inhibit bone resorption. Accordingly, an open population of 39 osteoporotic women was studied in order to determine BMD variations in lumbar vertebrae and femoral neck and to confirm whether given APD doses increase bone mineralization. A parallel group of osteoporotic women was likewise evaluated to determine the potential reversibility of such effect on discontinuing treatment. Results were beneficial at both skeletal sites in subjects on APD therapy, disclosing at 18 months treatment 9.0% mean peak mineral gain versus basal status at lumbar spine. In the few responders completing 4 years of treatment, mean differences versus basal status were +4.9% in vertebrae and +6.2% at femoral neck. In lumbar vertebrae there was a rapid trend in mineral gain up to 18 months on treatment, which declined thereafter to a quarter of its early rate. Concurrently, in the group of 21 baseline-matched women, effects were evaluated after discontinuing daily APD administration one year (n = 11) or two years (n = 7) later. In both subgroups, there was a loss in lumbar (-7.1% and -9.8% respectively; p<0.01) and femoral neck BMD (-2.2% and -4.2% respectively; p: n.s.) on performing measurement one year after APD withdrawal. Furthermore, after three years treatment and subsequent discontinuance, three patients presented bone loss in lumbar vertebrae and minimal changes at femoral neck one year after APD withdrawal. Therefore, APD induces moderate BMD gain which proves reversible on discontinuing therapy, so that it seems unlikely that this compound should "freeze" bone metabolism to a significant extent. However, the precise degree of such reversibility requires evaluation in larger series.

Administration, Oral↗
PubMed1995

Serum kinetics, bioavailability and bone scanning of 99mTc-labelled sodium olpadronate in patients with different rates of bone turnover.

The activity of olpadronate labelled with technetium-99m(99mTc) was monitored in plasma and urine samples after single oral (925 MBq 99mTc/10 mg, coadministered with 50 mg cold drug) and intravenous (925 MBq 99mTc/5 mg) administrations to two groups of patients with different rates of bone turnover. The first group comprised high bone turnover (HBTO) patients suffering from Paget's bone disease; the second group comprised patients with normal to low bone turnover (NBTO) having the diagnosis of rheumatoid arthritis and secondary osteoporosis. Kinetic variables were correlated with anthropomorphometric variables, biological markers of bone metabolism and plasma proteins. Data were also obtained after repeatedly dosing the HBTO patients. Additionally, Paget's bone and healthy bone (PB/HB) uptake before and after low-dose oral treatment were assessed by means of scintigraphy. Results showed that most of the kinetic variables did not differ between the two groups of patients, except for a greater Vss and smaller blood area under the curve AUC in the patients with HBTO. After a repeated-dose administration period, the blood AUC activity and Whole Body Retention (WBR) of the HBTO patients tended to be similar to those of the NBTO patients. In both groups, after oral dosing, the Cmax was 20 times lower than the C0.5 after i.v. injection, and the oral bioavailability ranged from 3% to 4%. Finally, the plasma t1/2 beta ranged from 9 to 14 h. Correlation coefficients were obtained from multiple regression analysis; kinetic variables showed very low correlations with anthropomorphometric measurements. In contrast the Vss and WBR were significantly correlated with serum alkaline phosphatase levels and the Vss also with urine hydroxyproline levels. Plasma protein concentration was also correlated with excretion parameters such as CLP and plasma t1/2 beta after an oral dose. Scintigraphic studies in the HBTO group allowed bone selectivity to be seen through skeletal drug uptake. The 15 Pagetic lesions analysed in the HBTO group showed a decrease in PB/HB ratio from 3.8 in the basal study to 2.7 after olpadronate administration for 30 days at the rate of 50 mg/day. In conclusion, the kinetic profile of 99mTc-labelled olpadronate, mainly AUC and WBR, showed a dependence upon bone metabolism and seemed unrelated to body size variables. HBTO patients showed a lower blood AUC but a higher Vss. Both variables may have been reflecting the fact that the drug binds selectively with calcified tissues and, in turn, with the target compartment. Scintigraphy confirmed the labelled-compound bone selectivity as a desirable feature for a bone-scanning agent.

Administration, Oral↗
PubMed1994

Preliminary study of multiple increasing oral doses of dimethyl-APD on bone metabolism dynamics and safety profile.

A random block study, with 50, 100, 200 and 400 mg of 3-dimethylamino-1-hydroxypropylidene-1, 1-bisphosphonate or dimethyl APD and 300, 600 and 900 mg of 3-amino-1-hydroxypropylidene-1, 1-bisphosphonate or pamidronate (APD), in daily oral doses, showed that all doses were active when assessed in patients with Paget's bone disease. Dimethyl APD administration was followed by an increase in 1.25 (HO)2D levels, an effect that must be confirmed. Neither severe side effects nor significant laboratory abnormalities were detected despite some decrease in white blood cell count seen with the higher dose of APD. Gastrointestinal tolerance of dimethyl APD was acceptable but further investigation is required.

Aged↗
PubMed1989

Chemiluminescence of ischaemic and reperfused intestine in vivo.

Low level chemiluminescence of exposed rat intestine was measured during occlusive ischaemia and reperfusion. Spontaneous emission of in vivo rat intestine (10 +/- 1 cps/cm2) decreased almost to zero in animals subjected to ischaemia and when the period of ischaemia lasted only two minutes, chemiluminescence increased beyond control levels (39%, three minutes after reperfusion) at intestine deligation. This overshoot did not occur when rats were pretreated with allopurinol (40 + 100 mg/kg bw). The ratio of xanthine dehydrogenase to xanthine oxidase activities was 3.46 in preischaemic intestine samples. The same ratio was changed to 0.35 in samples subjected to two minutes of ischaemia. As chemiluminescence appears to reflect the steady state level of singlet oxygen, which in turn derives from the steady state level of peroxy radicals, these results agree with the view that oxygen radicals derived from the xanthine oxidase reaction are involved in the cellular damage produced after ischaemia and reoxygenation in the intestine.

Allopurinol↗
PubMed1989

[Kinetics of chemoluminiscence of rat intestine during ischemia and reperfusion].

Oxygen free radicals are involved in ischemic and reperfusion tissular injuries. Chemiluminescence of organs reflects the steady state level of peroxy radicals, usually generated by oxygen radicals. In this study, chemiluminescence of intestine has been determined in rats subjected to 2, 5 or 10 min of occlusive ischemia by ligation. During the ischemic period, chemoluminescence tends to decrease. After delegation, a constant response, a chemiluminescence overshoot, can be obtained only in the group of rats subjected to 2 min of ligation. This methodology does not provide constant results with longer periods of ligation. In other groups of rats subjected to 2 min of ligation and then delegated, the kinetics of the organ emission in function of time show a mean overshoot of about 44% after 3 min of reperfusion. This early excess of chemiluminescence is maintained for the first 10 to 20 min after delegation, but not for longer periods. The administration of a free radical scavenger, thioctic acid 100 mg/kg i.p., prevents or reduces the amount of the overshoot previously described during the 20 min postdelegation follow-up period. These data suggest that excessive oxygen radical generation occurs in vivo during the early minutes of reperfusion and may be the consequence of very fast enzymatic changes during the short-term previous hypoxic period. Further studies are needed to demonstrate the subsequent functional alteration and the pathological implication of this phenomenon.

Analysis of Variance↗